tbuckley/cabot-search huggingface dataset:
Abstract 13266: Sex Specific Differences in the Gut Microbiome in Patients With Pulmonary Arterial Hypertension
Authors: Madelyn Blake, Daphne Moutsoglou, Alexander Khoruts, Edward K Weir, Thenappan Thenappan
Journal: Circulation (2022)

Introduction: Pulmonary arterial hypertension (PAH) patients exhibit sexual dimorphism in pulmonary vascular remodeling and right ventricular (RV) dysfunction. While female PAH patients have severe pulmonary vascular remodeling, male PAH patients have worse RV function. Inflammation, a key component of PAH pathobiology, has been implicated as a potential mechanism for sexual dimorphism. Gut dysbiosis causes systemic inflammation. However, it is unknown whether gut dysbiosis contributes to sexual dimorphism in PAH. Hypothesis: There are sex-specific differences in the gut microbiome and microbial metabolites of PAH patients. Methods: 16S ribosomal ribonucleic acid gene sequencing was performed on stool samples from PAH patients (n=73). Markers of inflammation and circulating microbial metabolites were measured using plasma samples. Results: There was no significant difference in the Shannon diversity indices or species richness (Chao1 indices) between the gut microbiomes of male and female PAH patients. Moreover, principal component analysis of pairwise Bray-Curtis dissimilarity indices revealed no distinct microbiome compositions dependent on sex. There was no difference in serum claudin-3, a marker of gut permeability, and serum interleukin 6 levels between male and female PAH patients. When examining microbial metabolites, including trimethylamine N-oxide, short chain fatty acids, and secondary bile acids, no sex-specific differences were observed. Linear discriminant analysis of effect size revealed that there were no taxonomic differences based on sex. Conclusions: Male and female PAH patients do not possess distinct differences in their gut microbiomes or metabolites. There are also no sex-specific taxonomic differences. These findings do not support our hypothesis that gut dysbiosis may serve as a possible explanation for the sexual dimorphism observed in PAH.
Abstract 13568: Characterization of the Maladaptive QTc Response During the Treadmill Exercise Test in Untreated Patients With Long QT Syndrome
Authors: Raquel Neves, Sahej Bains, Johan M Bos, Ciorsti MacIntyre, John Giudicessi, Michael J Ackerman
Journal: Circulation (2022)

Background: Long QT syndrome (LQTS) is a genetic heart disease affecting about 1 in 2000 persons. Around 40% of patients with LQTS can have a nondiagnostic, normal QTc at rest. The treadmill exercise stress test (TEST) can help unmask patients with concealed LQTS with a characteristic maladaptive, paradoxical increase in QTc ( 460 ms) during the recovery phase. In fact, the recovery phase QTc value has been added to the latest diagnostic score for LQTS. Objective: To characterize the TEST-derived QTc profile of untreated patients with LQTS and determine its diagnostic and prognostic utility. Methods: Retrospective analysis was performed on TEST data derived from 249 patients with LQTS (129 LQT1, 64 LQT2 and 56 LQT3) untreated at the time of their TEST compared with 236 controls. The Bazett’s corrected QTc was calculated at rest (sitting, supine, and standing), during exercise at 1 min, 3 mins, and peak exercise, and during recovery phase at 1, 3 and 5 mins. Results: The mean resting QTc was significantly higher in LQTS patients (457 ± 30 ms) compared to controls (420 ± 24 ms; p&lt;0.0001) as well as at every stage during the TEST (p&lt;0.001). For LQT1 patients, highest QTc was observed at peak exercise (mean 496 ± 38 ms) and during the third minute of recovery phase (mean 500 ± 40 ms). In contrast, LQT2 patients showed the lowest QTc (mean 452 ± 48 ms) during peak exercise but the greatest QTc latency (QTc at 5 min - QTc at 1 min recovery; mean QTc latency 33 ± 77 ms; p=0.005) compared to controls. For LQT3, the mean QTc was greatest at rest compared to controls (p&lt;0.001), and there was no difference during exercise and recovery phases. Among 162 LQT1 and LQT2 patients that presented with concealed LQTS, 119 (73%) showed a maladaptive QT response. ROC analysis showed that in patients with LQT1, a maladaptive QTc &gt; 523 ms at 3 min of recovery was highly predictive of breakthrough cardiac events (AUC 0.84; sensitivity 100%, specificity 72%); no such association was identified for LQT2 or 3. Conclusions: This comprehensive characterization of the QTc response before, during, and after a TEST in the largest untreated cohort of patients with LQTS provides important genotype-specific characteristics and can be used as a predictor for potential LQT1-triggered cardiac events after diagnosis and treatment.
Abstract 13714: Clinical Characteristics and Comparative Outcomes of Patients Undergoing Angiovac Endovascular Debulking of Tricuspid Valve Endocarditis versus Medical Therapy in Patients Considered Non-Surgical Candidates
Authors: Mian Tanveer Ud Din, Sheng Fu, Srikanth Radhakrishnan, Namita Joseph, Adnan Khalif, Rachel A Hughes-doichev, david lasorda, Mithun Chakravarthy, Anita U Radhakrishnan, Amresh raina
Journal: Circulation (2022)

Introduction: There remains a paucity of research regarding clinical characteristics and comparative outcomes of patients with tricuspid valve (TV) endocarditis, considered non-surgical candidates, undergoing debulking of TV vegetations using the AV(AngiVac) device compared to medical therapy. Methods: We conducted a retrospective cohort study at a single tertiary referral center comparing patients with TV endocarditis who were not considered surgical candidates. We compared clinical characteristics and outcomes in patients who underwent debulking of TV vegetations with AV vs those who were treated with medical therapy. Results: A total of 75 patients with TV endocarditis were included in the study. At baseline, patients in the medical therapy group were younger (34.4 years ± 10.5 vs 48.6 years ± 21, p &lt; 0.0003), more frequently male in gender (55.9% vs 44%, p &lt; 0.39) and had higher incidence of intravenous drug use (93.2% vs 56%, p &lt; 0.0002). Patients were more likely to have history of malignancy (6% vs 1.7%, p &lt; 0.32), cardiac implantable electronic device (31% vs 8.5%, p = 0.02) and central venous access (19% vs 1.7%, p = 0.01) if they underwent AV. Medical therapy was more commonly used for relatively smaller TV vegetations (1.68 cm vs 2.9 cm, p &lt; 0.0001). Medical therapy was also associated with higher complication rates including distal embolization (81.4% vs 0%, p &lt; 0.0001) and cerebrovascular accidents (5.1% vs 0% p = 0.36). In hospital mortality was similar for both groups and length of stay remained unchanged. Conclusions: Debulking of TV endocarditis with AV is feasible in patients not deemed to be surgical candidates and is not associated with higher inpatient mortality or length of stay. There was a lower rate of distal embolization and cerebrovascular accident in patients undergoing AV. Larger, multi center studies are needed to evaluate whether AV might improve outcomes in patients with TV endocarditis and large vegetations not deemed surgical candidates.
Abstract 13436: Sex-Specific Predictors of Postoperative Atrial Fibrillation and the Role of Cardiometabolic Diseases
Authors: Amelie Paquin, Jeanne Roberge, Pierre Voisine, Marie-Annick A Clavel, Paul Poirier, Marie E Piche
Journal: Circulation (2022)

Introduction: Cardiometabolic diseases increase the risk of postoperative atrial fibrillation (POAF), which in turn is associated with higher long-term risk of major cardiovascular events (MACE). Little is known regarding the sex-specific impact of cardiometabolic diseases on POAF risk. We evaluated the sex-specific predictors of POAF after coronary artery bypass grafting (CABG), with a focus on preoperative cardiometabolic profile. Methods: In a prospective registry of patients undergoing isolated CABG (2006-2019), we compared predictors of POAF between sexes. We excluded patients with previous AF history, redo/urgent/off-pump CABG, perioperative mortality, and permanent pacemakers/defibrillators. Abdominal obesity was defined as a waist circumference (WC) &gt;102 cm (men [M]) or &gt;88 cm (women [W]). Results: We included 7,851 patients (19% women). Baseline characteristics are presented in Table 1. POAF occurred in 27% of women and 31% of men (p&lt;0.01). Women were older and had a higher prevalence of comorbidities, abdominal obesity and a worse lipid profile. In a logistic regression model adjusting for the variables in Table 1, men had a higher risk of POAF (OR M = 1.4 [1.2-1.6], p&lt;0.01). When stratifying by sex, significant predictors (p&lt;0.05) of POAF for both sexes were age, WC (OR M = 1.04 [1.00-1.08]; OR W = 1.01 [1.00-1.03]), and triglycerides (TG) (OR M = 0.98 [0.97-0.99]; OR W = 0.97 [0.95-0.99]). Sex-specific predictors were creatinine for women and beta-blockers, extracorporeal circulation time, intensive care stay and hemoglobin for men. Conclusions: Women had less POAF but worse preoperative cardiometabolic profile compared to men. WC was a strong predictor of POAF for both sexes, while higher TG levels were protective. Since POAF is linked to future risk of MACE, the preoperative clinical assessment of WC should be encouraged and targeted for preventive strategies, especially in women. More studies are needed to investigate the role of TG in POAF.
Abstract 13593: Rates of Acute Kidney Injury or Discontinuation After SGLT2 Inhibitor Initiation in a Real-World Cohort of Patients With Heart Failure With Reduced Ejection Fraction
Authors: Bryan Perez Martinez, Sarah Adie, Matthew C Konerman
Journal: Circulation (2022)

Background: SGLT2 inhibitors (SGLT2i) decrease mortality and risk of hospitalizations in patients with HFrEF. SGLT2i have a natriuretic effect shortly after initiation, followed by a lasting osmotic diuretic effect. We sought to evaluate real-world rates of acute kidney injury (AKI) in our clinical setting that includes patients concurrently receiving high doses of loop diuretics. Methods: We abstracted patient level data on 200 patients with HFrEF initiated on a SGLT2i in the outpatient setting in the University of Michigan (1/7/2016 - 2/7/2022). Our co-primary endpoints were rate of AKI and discontinuation of SGLT2i. Secondary end points consisted of diuretic dose reduction, change in potassium, change in serum creatinine (SCr), and other side effects not requiring discontinuation. Results: The majority of patients were male (64%) with a mean LVEF of 27%. A total of 104 (52%) patients had diabetes mellitus. The majority of patients (54%) were taking an angiotensin-receptor neprilysin inhibitor. The mean daily furosemide equivalent diuretic dose was 93.3 mg. Twenty-two (11%) patients had AKI and 18 patients (9%) discontinued their SGLT2i. Yeast infection (3%), hypotension (2.5%), and AKI (2%) were the most common reasons for discontinuation. Using ROC curve analysis, the strongest predictors for AKI were A1C (AUC = 75.8, empirical confidence interval [ECI] 66.5-83.5); baseline SCr (AUC = 72.0 ECI 65.7-78.7); LVEF (AUC = 67.6 ECI 58.4-75.8); and furosemide equivalent diuretic dose (AUC = 66.0 ECI 57.5-74.6). Similarly, the strongest positive predictors for SGLT2i discontinuation were A1C (AUC = 81.1 ECI 74.8-87.2); baseline Scr (AUC = 67.4 ECI 58.7-75.5); LVEF (AUC = 68.7 ECI 58.9-76.5); and furosemide equivalent diuretic dose (AUC = 67.2 ECI 58.2-76.0). Conclusions: A1C was the strongest predictor of AKI and SGLT2i discontinuation in HFrEF patients started on SGLT2i. Glucosuria may be related to this effect. SCr, LVEF, and furosemide equivalents also predicted these outcomes.
Abstract 13256: Prognosis of Congestive Heart Failure Due to Chagas Disease in Women and Men
Authors: Antonio de Padua Mansur, Carlos H del Carlo, Edimar A Bocchi, Antonio C Pereira-Barretto
Journal: Circulation (2022)

Introduction: Chronic Chagas cardiomyopathy (CCC) is one of the leading causes of congestive heart failure (CHF) in Latin America and carries a high morbidity and mortality burden. Previously, it was believed that there was no epidemiological and clinical evidence of a gender-associated risk of death in patients with CCC. Hypothesis: to analyze the mortality of congestive heart failure due to CCC in women and men. Methods: From February 2017 to September 2020, we followed a cohort of patients with CHF due to CCC in a single-center outpatient clinic. Serologic tests defined Chagas disease. Baseline data included clinical characteristics and echocardiographic findings. Statistical analyses were performed with the Kaplan-Meier method and Cox proportional hazards methods. Results: We studied 733 patients, mean of 61.4 ± 12.3 years, and 381 (52%) males. At baseline, women were older (63.0±11.9 vs. 60±12.4 years; p=0.01), had a higher prevalence of CKD (9.7 vs. 5.1%; p=0.002), higher mean left ventricular ejection fraction (LVEF) (44.5±14.6% vs. 37.3±14.8%; p&lt;0.001), and a lower left ventricular diastolic diameter (LVDD) (56.7±8.9 vs. 62.4±9.4 mm; p&lt;0.001). Over a 3-years follow-up period, 294 patients died being 168 (57%) men and 126 (43%) women (log-rank; p=0.002). Women had more implantable pacemakers (26.1% vs. 16.5%; p=0.002) and men more implantable cardioverter-defibrillators (20.7% vs. 12.5%; p=0.003). Heart transplants occurred in 10.8% of men and 7.4% of women (p=NS). Cox regression for death adjusted for age, sex, previous myocardial infarction, diabetes, previous stroke, chronic kidney disease (CKD), atrial fibrillation, and LVEF showed men (HR=1.4; 95%CL:1.1-1.8), previous stroke (HR=2.4; 95%CL:1.5-3.6), diabetes (HR=2.0; 95%CL: 1.3-3.1), and CKD (HR=1.8; 95%CL:1.3-2.6) as the main predictors of death. Conclusions: women had a better prognosis than men. Treatment of comorbidities will significantly reduce the death rate in CHF due to CCC.
Abstract 13777: Metabolic Phenotyping in Aortic Stenosis: Insights From a Multi-Parametric Cardiac Magnetic Resonance Study
Authors: Shveta Monga, Ladislav Valkovic, Masliza Mahmod, Saul G Myerson, Stefan Neubauer, Oliver J Rider
Journal: Circulation (2022)

Introduction: Left ventricular hypertrophy in Aortic stenosis (AS) results from pressure overload and relates to perturbations in cardiac fatty acid metabolism with evidence of steatosis and deranged myocardial energetics in severe AS. There is, however, wide individual heterogeneity in the degree of hypertrophy and progression to myocardial fibrosis and heart failure. Underlying interplay of metabolism and hypertrophy may explain this variability. Purpose We sought to determine if a gradient of myocardial metabolic remodelling exists in AS and its relationship with AS severity, degree of hypertrophy and fibrosis. Methods: 74 asymptomatic AS participants including mild (n=18), moderate (n=38), severe (n=18), and 13 healthy volunteers underwent CMR imaging for cardiac function, myocardial PCr/ATP and triglyceride content (MTG) assessment. Participants were divided into quartile groups based on LV wall thickness (LVWT) and peak aortic valve gradient (AVG) to study relationship between cardiac metabolism and hemodynamic markers of LV structure and function. Results: There was a stepwise deterioration in LV structure and function in both the LVWT and AVG quartile groups (p values significant) with increasing AS severity, as expected. Notably, PCr/ATP was reduced early in mild-moderate AS (Q2 1.43±0.13 vs 1.80±0.14 in Q1 controls, p=0.05) with a progressive decline across groups (Q4 PCr/ATP 1.39±0.14, p=0.02 vs Q1). MTG was elevated in mild-moderate AS (Q2 1.52±0.84 vs 1.25±0.70% in Q1, p = 0.032). Global longitudinal strain was impaired across all AS groups, and was related to the degree of energetic impairment (R 0.219, p 0.03). In addition, PCr/ATP was strongly associated with the presence of myocardial fibrosis (p 0.01). Conclusion A gradient of myocardial energetic deficit and steatosis exists across the spectrum of hypertrophied AS hearts, notably these metabolic changes precede irreversible LV remodelling and subclinical dysfunction.
Abstract 13403: Substance Use is Associated With an Increased Risk for Hospital Readmission and Mortality in Patients With Heart Failure
Authors: Samantha L Yeung, Mengxi Wang, Mimi Lou, Tien M Ng
Journal: Circulation (2022)

Introduction: Both heart failure (HF) and substance use disorders are associated with substantial morbidity and mortality. Many illicit substances exert adverse cardiovascular effects and socioeconomic impact. Hypothesis: Substance use will be independently associated with worse clinical outcomes in patients with HF. Methods: Retrospective, cohort study of adult patients with a primary diagnosis of HF enrolled in the Optum Clinformatics Data Mart (2010 – 2020). Demographics and clinical outcomes were obtained via ICD-9/10 codes. Patients were stratified by history of substance use [anytime; prior or current use; type of substance (i.e., cannabis, opiates, stimulants – cocaine and methamphetamine, and hallucinogens – phencyclidine and sedative/hypnotic/anxiolytics)] and compared to patients with no history of substance use. A multivariable logistic regression analysis was conducted in a propensity-score 1:1 matched cohort. Outcomes were 30 and 180-day, and 1-year hospital readmission and mortality. Results: There were 184,508 patients included; 11,611 (6.3%) with documented substance use at any time. Prior to matching, patients with substance use were younger, more often male, and with fewer comorbidities compared to those with no history of substance use. Substance use was associated with greater 30 and 180-day, and 1-year hospital readmissions and mortality (table). The associated risk of substance use was confirmed in the propensity matched analysis. The risk was retained when substance use was restricted to use prior to or at time of index hospitalization and use after index hospitalization. Stimulant use was associated with a 2-fold increase in risk of hospital readmission. Conclusions: Despite younger age and fewer comorbidities, substance use in patients with HF was associated with an increased risk of all-cause and HF-related hospital readmissions and mortality.
Abstract 13342: Validation of the European Society of Cardiology Systematic Coronary Risk Evaluation 2 Prediction Algorithms in a Non-European (United States) Contemporary, Community-Based Historical Cohort
Authors: Betsy J Medina-Inojosa, Jose R Medina-Inojosa, Mohammad Ali Sheffeh, Rosana Bianchettin, Amir Lerman, Francisco Lopez-Jimenez
Journal: Circulation (2022)

Introduction: Newly developed Systematic Coronary Risk Evaluation-2 (SCORE-2) and the version for older people [(SCORE2-OP) ≥70 years] algorithms for 10-yr incident cardiovascular disease (CVD) have been derived incorporating European and US populations. Its performance has not been externally validated in community-based populations representative of real-world clinical practice. Hypothesis: We tested the hypothesis that the SCORE-2 and SCORE2-OP algorithms will accurately estimate 10-yr risk of first-onset CVD in this population. Methods: Consecutive patients who, between 1998-2000, sought primary care in Olmsted county, MN, and were followed-up using the Rochester Epidemiology Project. Inclusion criteria were set as those used in the derivation of the original algorithm. The composite outcome of CVD was defined as first myocardial infarction, ischemic stroke, or cardiovascular mortality. We compared predicted and observed events and generated C-statistics across predefined risk subgroups. Results: We included 22,858 adults, mean age of 55.11±11.58 (13.50% &gt;70 yr) 54% females. After a mean follow-up of 9.55±1.5 yr, 2,145 events were observed. 6.39% of subjects for SCORE-2 and 59.88% using SCORE2-OP were considered at high risk. Overall, the SCORE-2 had better discrimination than the SCORE2-OP (C-statistic: 0.72 and 0.64, respectively) (Fig B-D). The algorithms performed better in individuals 50-69 yr while underpredicting in younger individuals and overpredicting CVD in ages above 70 (in the low and moderate risk group) (Fig A-C). Prediction was mostly similar between men, women and middle-aged individuals but demonstrated pronounced underprediction in older men (Fig B-D). Conclusions: The SCORE-2 Risk prediction tool performed with marginal results whereas the SCORE2-OP had poor performance when predicting CVD events in a community cohort representing real-world clinical practice in a non-European population.
Abstract 13391: Exploring Prognostic Implications of Socioeconomic Status in Patients With Peripheral Arterial Disease
Authors: Nayla Leveille, Mia Chen, Benedicte Nauche, Laura M Drudi
Journal: Circulation (2022)

Introduction: This systematic review sought to describe the prognostic implications of SES on clinical outcomes in patients undergoing vascular interventions for claudication and critical limb threatening ischemia (CLTI). Hypothesis: Methods: Studies were systematically searched across 5 databases from inception to June 2021. Studies focused on patients with claudication or CLTI undergoing open, endovascular, or hybrid procedures. Studies were included if SES was documented and associated with a clinical outcome. Two independent reviewers selected studies for inclusion, extracted data, and assessed risk of bias using ROBINS-I and Newcastle-Ottawa scales. Extracted data included study and clinical characteristics, demographics, interventions, outcome measured, and association of SES with the clinical outcomes. Results: Thirty four studies met our inclusion criteria and addressed the impact of SES in patients undergoing interventions for PAD, with 8 articles including only claudication patients, 2 including only CLTI patients, and 24 including a combination of both groups. The way SES was defined varied across studies, with some describing it in relation to insurance status (n=14), household income (n=13), income in area of living (n=8), income in the hospital’s area (n=1) and employment status (n=1). Low SES was associated with higher rates of amputation as a primary intervention, higher rates of above the knee amputation compared to below the knee amputation, higher 30 day postoperative death, longer lengths of stay, higher surgical sites infections, amputations following primary interventions, in-hospital complications, long term major adverse limb events and long term amputation rates. Given the amount of heterogeneity that was present in the designs, populations, and comparators among the included studies, we were unable to statistically pool data across trials. Conclusions: Our qualitative findings suggest that low SES is associated with significant adverse outcomes in patients with PAD including higher rates of primary amputation, post-operative mortality, length of stay, among others. Reasons for these disparities should be explored to identify solutions for decreasing and eliminating these health inequities.